Roy Rosin spent a decade in Silicon Valley as innovation boss at Intuit (which makes TurboTax and Quicken software), then headed east five years ago to start as chief innovation officer for Penn's $5 billion-a-year medical complex.
That's a fancy way of saying he finds ways to use software and gadgets to cut costs and boost patient results, working with University of Pennsylvania medical, nursing, engineering, and Wharton scholars, dominant local insurer Independence Blue Cross, and neighborhood investors looking to bet on sexy start-ups.
People at Penn "were used to seeing M.B.A.s and professors who came in and said, 'I'm here to solve your problem.' Or engineers who said, 'This is just SMOP,' a small matter of programming - yeah, right!" Rosin said.
With his Silicon Valley background and Stanford M.B.A., Rosin tried a fast-track collegial approach, recruiting scholars for the "Innovation Accelerator" teams he is building to unite "creative business thinkers alongside innovative technicians," to address what he calls "the big, intractable problems" in health-care delivery.
"Many of the big, costly health problems out there have to do with human decision-making and how people interact with systems," Rosin said. "Behavioral science is critical. Design is critical. It is really fun to see the impact of these perspectives coming together."
Health care is a war zone of perverse incentives. The federal government, while expanding coverage until it pays roughly half the nation's medical bills, has also limited reimbursement rates, forcing hospitals to economize.
"In the old world, we were paid more than our cost," Rosin said. "In the new world, we're not paid close to our cost. . . . It creates a really morbid calculation: If somebody dies, there is no cost to the payer. But if somebody [is disabled], there is a high cost. So the insurer has to ask every time: 'After we do this care, is this patient still going to be my member?' " Will that care boost, or prevent, future claims?
The calculation is simpler - and more patient-friendly - for practices that cost a little money now, but can prevent the patient from developing a not-fatal condition needing costly long-term treatment.
Take diabetic retinopathy. "It is a common, and it is the most preventable, blindness in the world," Rosin said. Ready for your eye exam, and dilating eye drops? Penn doctors have found that many people consider the process and follow-up inconvenient. Their conditions are not diagnosed in time.
So, technology: "Some brilliant engineers have invented a camera that doesn't need dilation. You don't need a caregiver if they use this," he said. "The question: Can we make this work in a real setting?"
Ophthalmologists at Penn's Scheie Eye Institute agreed to test the cameras, betting that the rise in screenings will balance the impact of a drop in late-stage cases.
Quick tests as a marker - do more research here! - is a Silicon Valley technique now adapted to more rigorous but much-slower-moving academic science, Rosin said. Another is "fake back ends" - marketing services that don't yet exist, like same-day Penn specialist appointments, to probe demand and develop quick, informal service arrangements.
For Rosin's Innovation Accelerator program, Courtney Schreiber, a physician who works with pregnancy complications, launched "eight pilot projects in 90 days. People said, 'Are you kidding?' That's not the cadence of health care," Rosin said. "I want the health system to operate on a cadence like Silicon Valley cadence. That means in days and weeks, instead of years. We are getting there."
Schreiber's project "worked insanely well" and is being considered at Pennsylvania Hospital and others, he added. "That's what we look for - reproducible results."
An Accelerator team built a dashboard screen to help track "super-utilizer" patients - so-called frequent fliers - for Anna Doubeni, a Penn family-medicine physician who studies "multi-factorial problems," such as the difficulty homeless people have keeping medicines cold.
Shreya Kangovi, working with the Accelerator group, developed IMPaCT, a community-health-worker management model to address complex family problems that delay care.
Don't insurers and Medicaid programs, with all their patient and payment data, already track heavy-user patients so they can be targeted for early intervention? "I don't think insurers' information is real time enough," Rosin said.
One Accelerator start-up company, Keriton, was formed by Penn engineering students - veterans of the Penn Apps Hackathon - working to help Penn lactation nurses improve mother's milk management. With backing from Penn Engineering dean Vijay Kumar and early financial support from University City-based DreamIt Health, the project won backing from FirstRound Capital's Dorm Room Fund and others.
By studding bottle sleeves with sensors, readers and transmitters, Keriton helps wean nurses from one of their most time-consuming tasks - tracking, planning, and measuring inventory for mother's milk - and frees them for patient care.
"The Philly ecosystem is coming together," joining software creativity to health planning, Rosin said. "Penn has this interesting advantage: Everything is on one campus," not separated by roads, rivers or city borders, as at Harvard or other leading schools. At Penn, "you can walk there."